individuals further might reveal how these older adults manage to
“compress morbidity and live longer.”
REFERENCES:
1. [No authors listed] National Center for Health Statistics. Health, United States, 2015:
With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD. 2016.
2. Goff DC, Jr., Lloyd-Jones DM, Bennett G, et al. J Am Coll Cardiol. 2014;63:2935-59.
3. Feinstein M, Ning H, Kang J, et al. Circulation. 2012;126:50-9.
4. Sanders JL, Arnold AM, Hirsch CH, et al. J Am Geriatr Soc. 2016;64:1242-9.
Take-aways
• Work is underway to
develop “competing risk
models” that estimate the
specific events that are
more likely to occur first
for various populations,
affording patients and
clinicians a more accurate
sense of real-life risk.
• By the time people are
75 years of age or older,
those who are susceptible
to atherosclerosis pretty
much have it.
TRITON-TIMI 38: Greater reductions in thrombotic CV events and stent
thrombosis with Effient + ASA vs clopidogrel + ASA*
Thrombotic CV events (primary composite of CV death, nonfatal
MI, nonfatal stroke) relative risk reduction (RRR) in STEMI-PCI
patients was 21% through 450 days (9.8% Effient + ASA vs
12.2% clopidogrel + ASA, P=0.02)1
— RRR was 30% through 7 days (5.5% Effient + ASA vs
7.8% clopidogrel + ASA, P=0.008) and 32% through 30 days
(6.5% Effient + ASA vs 9.4% clopidogrel + ASA, P=0.002)2,3
Difference in treatments was primarily driven by a significant
reduction in nonfatal MIs, with no significant difference in CV death
or nonfatal stroke1
— In the overall study population, approximately 40% of MIs
occurred periprocedurally and were detected solely by changes
in CK-MB
Stent thrombosis (secondary endpoint) RRR in ACS-PCI
patients was 52% through 450 days (1.1% Effient + ASA vs 2.2%
clopidogrel + ASA, P<0.0001)4
Stent thrombosis RRR in STEMI-PCI patients was 42% through
450 days ( 1.6% Effient + ASA vs 2.8% clopidogrel + ASA,
P=0.02)5
SELECTED SAFETY: Effient increased the risk of TIMI
major or minor bleeding vs clopidogrel
Effient can cause significant, sometimes fatal, bleeding. Overall
rates of non-CABG TIMI major or minor bleeding were
significantly higher with Effient + ASA (4.5%) compared with
clopidogrel + ASA (3.4%). The rates of fatal bleeding were 0.3%
with Effient + ASA and 0.1% with clopidogrel + ASA. In patients
who underwent CABG (N=437), the rates of CABG-related TIMI
major or minor bleeding were 14.1% with Effient + ASA and 4.5%
with clopidogrel + ASA
*In TRITON-TIMI 38, the LD of clopidogrel was delayed relative to the placebocontrolled trials that supported its approval for ACS.1
Effient is indicated to reduce the rate of thrombotic cardiovascular (CV) events (including stent thrombosis) in patients with acute coronary
syndrome (ACS) who are to be managed with percutaneous coronary intervention (PCI) as follows: [1] patients with unstable angina (UA) or
non–ST-elevation myocardial infarction (NSTEMI); [2] patients with ST-elevation myocardial infarction (STEMI) when managed with primary
or delayed PCI.
The loading dose (LD) of Effient is 60 mg and the maintenance dose (MD) is 10 mg once daily. Effient is available in 5-mg and 10-mg tablets.
IMPORTANT SAFETY INFORMATION
WARNING: BLEEDING RISK
Effient® (prasugrel) can cause significant, sometimes fatal, bleeding.
Do not use Effient in patients with active pathological bleeding or a
history of transient ischemic attack or stroke.
In patients ≥75 years of age, Effient is generally not recommended,
because of the increased risk of fatal and intracranial bleeding
and uncertain benefit, except in high-risk situations (patients with
diabetes or a history of prior myocardial infarction [MI]) where its
effect appears to be greater and its use may be considered.
Do not start Effient in patients likely to undergo urgent coronary
artery by